Spinal purulent epiduritis (external pachymeningitis, spinal epidural abscess, purulent peripachymeningitis) is a rapidly developing purulent inflammation of the epidural tissue of the spinal cord. The disease is of a secondary nature and occurs due to the penetration of a bacterial infection from the focus of purulent inflammation into the epidural space. The nature of the disease can be diffuse (spread out) or limited (in the form of separate foci of varying sizes).
Epidural abscesses most often develop in the posterior epidural space, which is due to the presence of a dense network of lymphatic slits in it and the absence of epidural tissue in the anterior section. The localization of purulent inflammation in most cases is observed in the middle and lower thoracic spine. The pia mater and spinal cord, as a rule, are not involved in the pathological process, however, degenerative-destructive and secondary inflammatory reactive changes can develop in them (as a result of the development of edema, intoxication, compression, disturbances in lympho- and hemodynamics).
Causes of spinal purulent epiduritis (external pachymeningitis)
There are several main reasons that provoke the development of spinal purulent epiduritis:
- direct transition of the infectious pathogen into the epidural space during tuberculous and osteomyelitic processes in the spine;
- spread of predominantly staphylococcal infection by hematogenous or lymphogenous route from purulent or infectious foci in the body (furuncle, abscess, etc.);
- direct penetration of infection into the epidural space during punctures (in isolated cases).
Causes
The disease occurs in the epidural part of the spinal cord. During development, inflammation covers the dura mater of the brain.
At the moment there is no consensus on the causes of the disease. Some scientists are of the opinion that the primary cause is infectious, others believe that the disease is an autoimmune reaction of the body due to other infectious diseases.
Factors causing epiduritis:
- Spine pathologies;
- Having had surgery on the spine or a puncture taken from it, as a result of which the infection damages the epidural spinal area and the patient feels constant fatigue.
Spine pathologies
Previous surgery
Symptoms of spinal purulent epiduritis (external pachymeningitis)
Spinal purulent epiduritis usually develops acutely, with fever (up to 40 °C), chills, general malaise and headaches. The chronic course is characterized by a gradual onset of the disease with less pronounced clinical symptoms.
Due to damage to the dorsal roots, hypoesthesia or segmental anesthesia, a pain syndrome of varying intensity develops with possible irradiation along the entire spine, and compression of the spinal cord occurs. When the inflammatory process spreads to the back muscles, swelling may occur.
During the first days, the pain is accompanied by increasing weakness in the limbs (mainly in the legs), as well as partial or complete dysfunction of the pelvic organs (with severe myelitic syndrome). As a result of compression of the spinal cord below the lesion, a decrease in sensitivity of the radicular or conduction type occurs, paresis and paralysis occur (mainly of the lower extremities), and bedsores form.
The transition of acute purulent epiduritis to a chronic condition is characterized by stabilization or some weakening of the compression syndrome:
- reduction of radicular pain;
- relative restoration of the functions of the pelvic organs;
- relative restoration of motor functions of the affected limbs;
- decrease in body temperature.
In the chronic course of the disease, there is a change in phases of exacerbation and attenuation of the pathological process.
Symptoms
Diagnosis presents certain difficulties, since the symptoms of spinal epiduritis are similar to the symptoms of other ailments. As a result, a diagnostic error is often made. The main manifestations of spinal epiduritis:
- Temperature increase;
- General weakness;
- Frequently recurring attacks of headache, dizziness;
- Partial or complete loss of their functions by the pelvic organs;
- Pain in arms and legs;
- Involuntary muscle contractions (this symptom is also a characteristic sign of radiculitis).
Diagnosis of spinal purulent epiduritis (external pachymeningitis)
The diagnosis is established after identifying typical clinical symptoms, studying the nature of the course of the disease and differentiation with transverse myelitis and other diseases that cause compression of the spinal cord (tumors, injuries).
Laboratory research:
- confirmation of the inflammatory process in the body (increased ESR, neutrophilia, shift in the leukocyte formula to the left);
- obtaining pus by puncture of the epidural space at the level of the lesion;
- lumbar puncture (to detect blockage of the subarachnoid space).
Of the instrumental diagnostic methods, MRI and CT provide the most complete information.
Epidurit in children
In childhood, this disease is rare. It mainly occurs in older people and those who already have some problems with the spine. The disease occurs in children if it is inherited. In childhood, the prognosis is more favorable, epiduritis is more treatable, and deaths are unknown. At the end of treatment, the child will not be any different from his peers.
For prevention, it is necessary to avoid hypothermia, especially the legs.
Treatment of spinal purulent epiduritis (external pachymeningitis)
Conservative treatment methods include intensive use of sulfonamide drugs and broad-spectrum antibiotics. If there is no effect, urgent surgical intervention is required - laminectomy (opening the spinal canal by removing the vertebral arches), removal of the abscess and drainage of the epidural space. After the operation, massive antibiotic therapy and rehabilitation therapy are prescribed. With timely treatment and the absence of dissemination of abscesses in the epidural space, the prognosis is favorable. At later stages of the disease, as a rule, the prognosis is unfavorable.
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About the disease
There is a common misconception that this disease can be treated with antibiotics. However, not promptly seeking professional medical help in case of spinal epiduritis is a sure step towards death. The most dangerous is the cicatricial adhesive form of epiduritis.
There are the following forms of spinal epiduritis: purulent, chronic, scar-adhesive, productive, adhesive, aseptic.
With purulent epiduritis, suppuration of the diseased areas gradually occurs. The chronic form occurs in the absence of timely treatment.
This disease can occur as a result of spinal tuberculosis, other infectious diseases affecting the entire body, and purulent inflammatory processes.
Without treatment
The disease eventually affects the brain. It can change the human body in a short time. It is important to remember that people with certain spinal problems are at risk.
Possible consequences after illness
Thanks to early diagnosis, it is possible to quickly begin treatment of the disease, which minimizes the risk of negative consequences. The chances of improving your health increase if the doctor detects the cause of the infection in time and if the surgical intervention is carried out by a qualified specialist.
A big mistake is made by those people who hope that epiduritis will go away after a course of drug therapy. The longer the operation is delayed, the greater the likelihood of various complications developing. In particular, a spinal epidural abscess passes from an acute to a chronic form.
If the pathology has become chronic, the patient faces consequences in the form of:
- reduction in sensitivity;
- fatigue;
- dysfunction of the pelvic organs;
- bedsores;
- paresis.
Forecast
The prognosis for epiduritis is determined by the time of diagnosis of the disease. With the purulent form of the disease, diagnosis is a relatively simple task. In the chronic form, epiduritis is often detected only during surgery.
In general, the prognosis depends
on 4 factors: timeliness of diagnosis; cause of the disease; coverage of the disease in various parts of the body; timeliness and quality of the operation. Timely surgical intervention leads to a positive outcome. But with chronic epiduritis, even after successful treatment, the patient becomes disabled, and a possible negative result is the death of the patient from complications.
Regimen after removal of pathology
It is important for a patient who has undergone surgery to eliminate epiduritis to be at rest, maintain bed rest, and adhere to a strict diet. Any physical activity is prohibited.
Resort treatment has a very beneficial effect on the patient’s recovery .
In addition to the methods listed above, large doses of drugs with antibacterial properties are prescribed. Under no circumstances should you violate the established dosages, much less resort to traditional medicine.
Diagnostics of local, diffuse and other types
Despite the fact that the disease requires immediate treatment, making an accurate diagnosis is not always easy. Epidurit has relatively nonspecific symptoms.
For example, manifestations of acute spinal abscess are similar to the following pathologies:
- meningitis;
- perirenal abscess;
- acute poliomyelitis;
- subcutaneous hematoma;
- polyneuritis;
- osteomyelitis and other diseases.
Therefore, differential diagnosis is mandatory. If doubts arise about the presence of local spinal epiduritis, the patient is referred to undergo a suboccipital puncture using a water-soluble contrast agent. The most accurate information can be obtained through CT and MRI.
It is worth mentioning separately why a suboccipital puncture is performed instead of a regular puncture. The first option is more dangerous in the presence of epiduritis, which is localized in the lower thoracic or lumbosacral regions. During the procedure, pus along with the needle may end up in the subarachnoid space, which will lead to purulent meningitis.
There is a similarity between chronic epiduritis and:
- spinal cord tumor;
- osteomyelitis;
- protrusion;
- herpes zoster;
- infection of the disc;
- pyelonephritis.
Initial diagnosis involves a spondylogram and myelography.
Types of epiduritis - purulent, chronic, scar-adhesive, productive, adhesive, aseptic
The dura mater is separated from the periosteum, which lines the spinal canal from the inside, by a space called the epidural. It contains connective tissue, fatty tissue and venous plexuses. For certain reasons, this space becomes inflamed, and a purulent focus often forms.
With the development of epiduritis, the patient's life is in serious danger. The disease is so severe that it is impossible to cope with it with medication alone.
People who delay seeing a doctor contribute to the worsening of the condition. Epidurit occurs in acute or chronic form.
Depending on the degree of prevalence of the disorder, pathologies are distinguished:
- limited (local) (the lesion is localized only in the area of the hernial protrusion);
- common unilateral;
- common bilateral;
- diffuse (spilled).
Classification of epiduritis:
- purulent (productive): accompanied by the accumulation of pus in diseased areas (spinal abscess);
- non-purulent (aseptic epiduritis) serous exudate is formed;
- acute: diffuse or limited
- chronic: occurs in the absence of adequate treatment;
- cicatricial adhesive epiduritis (adhesive): fibrous cords form, often in the postoperative period.
